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The paper takes a scientometric approach to measure the change in research productivity of Italian academics before the COVID-19 pandemic outbreak. We propose a composite output/input bibliometric indicator and apply it at the field level, conducting a longitudinal analysis. Although the number of academics in the national academic system has decreased, we register very strong growth in both the number of publications and their scholarly impact. The growth in productivity, with only rare exceptions, crosses almost all fields. However, in areas that are traditionally very internationalized (Biology, Physics, and Chemistry), growth is less sustained than overall average, and also the variability of productivity across fields seems reduced. The main reason for this detail would be the smaller margins for improvement in the fields that had already reached high international standing. What emerges from the analysis goes counter to some alarms of declining scientific productivity at the global level. The Italian case is partly explained by the historic adoption of policies aimed at strengthening competitive mechanisms, in particular through the introduction of systems of performance-based research funding, and bibliometric accreditation for professorship. [ABSTRACT FROM AUTHOR]

Advancements in genomics have significant implications for public health, making citizens' education vital for informed decision-making. Based on two literature reviews' findings and a survey conducted with experts from the Italian Network of Genomics in Public Health, we conducted a pilot survey on Italian citizens' attitudes, knowledge and educational needs toward genetic testing and omics sciences. Our results demonstrate a widespread interest in genetic testing and uncertainties regarding associated risks, with 99% of participants acknowledging insufficient knowledge of genetic testing. There is an urgent need for educational tools to improve citizens' literacy and engagement in this rapidly evolving field. [ABSTRACT FROM AUTHOR]

Background Disability does not simply affect the health status of the individual who directly experiences that condition, but it has important consequences on the health and well-being of the other family members as well. Focusing on Italy, an extremely interesting test-bed due to its strong familialist welfare regime, we show significant spillover effects of children's disability on parental health and well-being. Methods We use data from a nationally representative household survey on almost 13 000 mothers and fathers and adopt a multivariate regression setting providing evidence that the disability of a child is negatively associated with parents' health and life satisfaction. Results Parents of a disabled child report lower levels of general and mental health, as well as lower levels of well-being compared with parents with a healthy child. Strong heterogeneity by gender and socio-economic characteristics is observed, with mothers being more affected by the disability status of the child than fathers. The estimated coefficients suggest that education remains an important protective factor even for parents of a disabled child. Conclusion This study claims and documents that child disability is an overlooked source of health disadvantage for parents. Such disadvantage is especially relevant for mothers and lower-educated parents, evidence that suggests the importance of taking an intersectional approach to study health disparities. [ABSTRACT FROM AUTHOR]

Background The European Union has used Healthy Life Years (HLY) as an indicator to monitor the health of its aging populations. Scholarly and popular interest in HLY across countries has grown, particularly regarding the ranking of countries. It is important to note that HLY is based on self-assessments of activity limitations, raising the possibility that it might be influenced by differences in health reporting behaviours between populations, a phenomenon known as differential item functioning (DIF). Methods We estimated DIF-adjusted HLY at age 50 for Belgium, France, Germany, Greece, Italy, the Netherlands, Spain, and Sweden to determine the extent to which differences in HLY might be influenced by reporting heterogeneity across countries. We used anchoring vignettes, taken from the 2004 Survey of Health, Ageing and Retirement in Europe, to estimate DIF-adjusted prevalence rates of activity limitations measured by the Global Activity Limitations Indicator (GALI). The Sullivan method was used to calculate DIF-adjusted HLY. Results Changes in HLY before and after adjustment ranged from a 1.20-year decrease for men in Italy to a 1.61-year increase for women in Spain. Adjustment for DIF produced changes in the rankings of the countries by HLY, with upward and downward movements of up to three positions. Conclusion Our results show that DIF is likely to affect HLY estimates, thereby posing a challenge to the validity of comparisons of HLY across European countries. The findings suggest that HLY should be used to monitor population health status within a country, rather than to make comparisons across countries. [ABSTRACT FROM AUTHOR]

Objectives Perfluoroalkyl acid surfactants are used in the chemical industry for the synthesis of perfluoroalkyl polymers. In one Italian fluoropolymer plant and in the research and innovation center, two major perfluoroalkyl surfactants have been historically used: PFOA and ADV and a third, cC6O4 substituted PFOA from mid-2013. This work is summarizing occupational exposure to these chemicals in the period 2004–2021, assessed by biological monitoring. Moreover, taking advantage of the phasing out of PFOA, the elimination kinetics of PFOA in humans is investigated. Methods Workers exposed to PFOA (from beginning of the sixties to 2013), ADV (since 1996), and/or cC6O4 (since 2012) in the production of fluoropolymers, in the synthesis, research, and analysis, were periodically surveyed from 2004, measuring the concentration of perfluoroalkyl acid surfactants in serum. Workers of the same plants, not directly exposed, were surveyed as well. Applying the first-order kinetics model, the half-life of PFOA was calculated. Results 809 Workers were investigated with measurements of PFOA (n = 3692), ADV (n = 4288) and cC6O4 (n = 2272) in serum. In the production plant, median PFOA ranged from 1900 to 14 µg/l from 2004 to 2021; median ADV ranged from 434 to 86 µg/l from 2011 to 2021. For cC6O4 the detection percentage ranged from 9 to 47%; in detected samples median cC6O4 ranged from 3 to 16 µg/l in the period 2013–2021. Adopted mitigation measurements included: the phasing out of PFOA, the improvement of the plastomer and elastomer post-treatments; the reinforcement of the staff involved in prevention. Decreasing trends were observed for all chemicals along years (P value for linear trend of means < 0.01). For PFOA, a half-life of 3.16 (95% CI 2.98–3.37) years was calculated. Conclusions In the study plants, several initiatives to reduce exposure and the risk associated with perfluoroalkyl surfactants were undertaken; results of biomonitoring show that they were effective, with a 5- to 136-fold reduction in the concentration of perfluoroalkyl compounds in the serum of workers. [ABSTRACT FROM AUTHOR]

Background the mySupport advance care planning intervention was originally developed and evaluated in Northern Ireland (UK). Family caregivers of nursing home residents with dementia received an educational booklet and a family care conference with a trained facilitator to discuss their relative's future care. Objectives to investigate whether upscaling the intervention adapted to local context and complemented by a question prompt list impacts family caregivers' uncertainty in decision-making and their satisfaction with care across six countries. Second, to investigate whether mySupport affects residents' hospitalisations and documented advance decisions. Design a pretest–posttest design. Setting in Canada, the Czech Republic, Ireland, Italy, the Netherlands and the UK, two nursing homes participated. Participants in total, 88 family caregivers completed baseline, intervention and follow-up assessments. Methods family caregivers' scores on the Decisional Conflict Scale and Family Perceptions of Care Scale before and after the intervention were compared with linear mixed models. The number of documented advance decisions and residents' hospitalisations was obtained via chart review or reported by nursing home staff and compared between baseline and follow-up with McNemar tests. Results family caregivers reported less decision-making uncertainty (−9.6, 95% confidence interval: −13.3, −6.0, P  < 0.001) and more positive perceptions of care (+11.4, 95% confidence interval: 7.8, 15.0; P  < 0.001) after the intervention. The number of advance decisions to refuse treatment was significantly higher after the intervention (21 vs 16); the number of other advance decisions or hospitalisations was unchanged. Conclusions the mySupport intervention may be impactful in countries beyond the original setting. [ABSTRACT FROM AUTHOR]

The current state of knowledge indicates that regular sports practice helps prevent and treat non-communicable diseases. The promotion of sport is, therefore, an important community health intervention for maintaining and improving the health of individuals and populations. Culture is identified as being associated with sports practice and sedentary behaviour of ethnic and national minorities. This study aims qualitatively to analyse the potential for culture as a basis for the promotion of sport among immigrants in four regions of Mediterranean Europe. Ten focus groups (n = 62) were conducted with immigrants—adults and young people over the age of 11—and people involved in promoting sport. Thematic content analysis was conducted. The results enabled identifying two major issues: sport as a vehicle for cultural expression and synergies between sport and culture. Accordingly, sport serves to express global, local and non-ethno-national cultural belonging. Regarding synergies, culture and sport feed each other positively and contribute to immigrants' health and cultural well-being. Culture as a strategy for promoting sports practice requires an interdisciplinary approach that involves collaboration between healthcare practitioners and social sciences professionals. There is also a need to use the various axes of cultural definition—global, local and non-ethno-national—of those involved, and for them to take part themselves in designing sports activities. Moreover, promoting sport through non-ethno-national axes of cultural definition may help with immigrants' social inclusion, as intercultural relations between migrants and newcomers are promoted. [ABSTRACT FROM AUTHOR]

Background Oncologists are often concerned that talking about death with patients may hinder their relationship. However, the views of death held by patients have not been thoroughly investigated. This study aimed to describe the perception of death among patients with advanced cancer receiving early palliative care (EPC) and their caregivers. Material and Methods Qualitative and quantitative analyses were performed on 2 databases: (a) transcripts of open-ended questionnaires administered to 130 cancer patients receiving EPC with a mean age of 68.4 years and to 115 primary caregivers of patients on EPC with a mean age of 56.8; (b) texts collected from an Italian forum, containing instances of web-mediated interactions between patients and their caregivers. Results Quantitative analysis shows that: (a) patients and caregivers are not afraid of speaking about death; (b) patients and caregivers on EPC use the word "death" significantly more than patients on standard oncology care (SOC) and their caregivers (P  < .0001). For both participants on EPC and SOC, the adjectives and verbs associated with the word "death" have positive connotations; however, these associations are significantly more frequent for participants on EPC (verbs, P s < .0001; adjectives, P s < .003). Qualitative analysis reveals that these positive connotations refer to an actual, positive experience of the end of life in the EPC group and a wish or a negated event in the SOC group. Conclusions EPC interventions, along with proper physician-patient communication, may be associated with an increased acceptance of death in patients with advanced cancer and their caregivers. [ABSTRACT FROM AUTHOR]

The study of national research assessment exercises serves to evaluate the effectiveness of policies versus their objectives and to improve the formulation of future initiatives. The aim of the current study is to verify whether the introduction of the first performance-based research funding in Italy, based on the 2004–10 VQR assessment, achieved the intended objective of inducing greater international collaboration on the part of researchers. For this, we apply a bibliometric approach based on the observation of coauthorships in Italian and worldwide scientific publications over a 14-year period, beginning in the target years of the VQR assessment. Through an Interrupted Time Series Analysis, we compare the expected and observed patterns of international coauthorship for Italy and the rest of the world. Although the rate of internationalization of Italian research is seen to be increasing, whether this is a consequence of the VQR incentives, or rather part of a global phenomenon of recourse to international collaboration in response to the increasingly complex scientific challenges, it is open to interpretation. [ABSTRACT FROM AUTHOR]

Background The aim of the present study was to compare the cross-sectional association between smoking and depressive symptoms among adolescents between Sweden and Italy, two countries historically characterized by different norms about tobacco use and different tobacco control efforts. Methods A cross-sectional study including 3283 adolescents 15–16 years of age participating in the Swedish KUPOL study and 1947 same-age adolescents from the Italian BE-TEEN study. Current smoking was defined as any smoking in the past 30 days. Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale for Children (CES-DC) and the internalizing score of the Strengths and Difficulties Questionnaire (SDQ). Country differences were explored in stratified and interaction analyses. Results Current smoking was associated with a 2- to 3-fold increased odds of depressive symptoms among Swedish adolescents using both CES-DC and SDQ internalizing scale. Among Italian adolescents, slightly lower increased odds of 1.5–2.5 for depressive symptoms with smoking were found using the CES-DC but not the SDQ scale. Both multiplicative and additive interactions for country were significant. The association between smoking and depressive symptoms was weaker among Italian compared with Swedish adolescents for both scores. Conclusions Countries with different tobacco norms and control show different associations between smoking and depressive symptoms in adolescence, probably due to different psychosocial profiles of smokers. These findings need to be considered when planning tobacco prevention programmes, e.g. by focusing on early detection of mental health distress among adolescents in settings with declining smoking prevalence and restrictive tobacco control environments. [ABSTRACT FROM AUTHOR]

Objective. People with transfemoral amputation have balance and mobility problems and are at high risk of falling. An adequate prosthetic prescription is essential to maximize their functional levels and enhance their quality of life. This study aimed to evaluate the degree of safety against falls offered by different prosthetic knees. Methods. A retrospective study was conducted using data from a center for prosthetic fitting and rehabilitation. Eligible individuals were adults with unilateral transfemoral amputation or knee disarticulation. The prosthetic knee models were grouped into 4 categories: locked knees, articulating mechanical knees (AMKs), fluid-controlled knees (FK), and microprocessorcontrolled knees (MPK). The outcome was the number of falls experienced during inpatient rehabilitation while wearing the prosthesis. Association analyses were performed with mixed-effect Poisson models. Propensity score weighting was used to adjust causal estimates for participant confounding factors. Results. Data on 1486 hospitalizations of 815 individuals were analyzed. Most hospitalizations (77.4%) were related to individuals with amputation due to trauma. After propensity score weighting, the knee category was significantly associated with falls. People with FK had the highest rate of falling (incidence rate=2.81 falls per 1000 patient days, 95% CI=1.96 to 4.02). FK significantly increased the risk of falling compared with MPK (incidence rate ratio [IRRFK-MPK]=2.44, 95% CI=1.20 to 4.96). No other comparison among knee categories was significant. Conclusions. Fluid-controlled prosthetic knees expose inpatients with transfemoral amputation to higher incidence of falling than MPK during rehabilitation training. Impact. These findings can guide clinicians in the selection of safe prostheses and reduction of falls in people with transfemoral amputation during inpatient rehabilitation. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic has had a huge effect on adolescents' health and learning. Health promotion strategies should be valued, and life skill education is a potential approach in this direction. This study aimed to investigate the implementation of an evidence-based life skill education programme during the COVID-19 pandemic in the Lombardy Region (Italy) by collecting opinions about the programme's usefulness and feasibility and identifying the strategies for implementing it through distance teaching. The study involved 63 middle school expert teachers, principals or coordinators in life skill education. An online questionnaire with closed- and open-ended questions was used. A qualitative content analysis was carried out using N-Vivo Answers software. The participants recognized the high value of life skill education at the time of COVID-19, but they showed reticence regarding its feasibility. Positive effects of the programme on both health and learning outcomes were reported. The obstacles were related to interpersonal aspects, student involvement, methods, organization and planning. Many strategies were suggested related to the teaching method, the curriculum organization and the adaptation needs. These strategies can be used to implement active and cooperative learning at a distance to reinforce students' life skills to cope with the crisis and promote their health. [ABSTRACT FROM AUTHOR]

Governments and organizations design performance-based research funding systems (PBRFS) for strategic aims, such as to selectively allocate scarce resources and stimulate research efficiency. In this work, we analyze the relative change in research productivity of Italian universities after the introduction of such a system, featuring financial and reputational incentives. Using a bibliometric approach, we compare the relative research performance of universities before and after the introduction of PBRFS, at the overall, discipline and field levels. The findings show convergence in the universities' performance, due above all to the remarkable improvement of the lowest performers. Geographically, the universities of the south (vs central and northern Italy) achieved the greatest improvement in relative performance. The methodology, and results, should be of use to university management and policy-makers. [ABSTRACT FROM AUTHOR]